The study, led by Andrew Harding and Reuben Tete Larbi of Lancaster University’s Division of Health Research, together with colleagues from Blackpool Council and the University of Liverpool, was funded by the National Institute for Health and Care Research through its Health Determinants Research Collaboration award. Rather than asking simply whether co-production works, the team used a realist approach, which asks a more nuanced set of questions: what works, for whom, how, and in what circumstances. Realist synthesis treats programmes as theories embedded in real-world systems, and its goal is to uncover the hidden causal pathways, the context-mechanism-outcome configurations, that explain why the same initiative can succeed in one place and disappoint in another.

The researchers began with scoping searches to identify key literature on co-production in local authority settings, drawing on five major databases: Scopus, CINAHL, Academic Search Ultimate, Web of Science and SocINDEX. From this body of work they constructed initial programme theories, which they expressed as context-mechanism-outcome configurations written in the form of if-then-because statements. These statements capture the logic of intervention: if certain conditions hold, then a particular outcome follows, because a specific mechanism is triggered. The configurations were organised under four themes: equity and inclusion, collaboration and systems change, ethical and sustainable engagement, and measurement and evaluation.

The analytical core of the study rested on 25 sources, but the team did not stop at the literature. In a deliberate effort to ground the synthesis in reality, they refined their theories through two workshops involving six participants with lived experience of local authority services and four local authority officers. Analysis was thematic, retroductive and iterative, meaning the researchers moved back and forth between the published evidence, their own theoretical framework and the insights of workshop participants, testing and refining each proposed pathway until it survived critical scrutiny. This design reflects a core principle of the research itself: that people who use services should help generate the knowledge about how those services are improved.

The synthesis produced nine context-mechanism-outcome configurations and an overarching programme theory, and its central finding is strikingly clear: trust is the engine of co-production. Trust emerged as the pivotal mechanism for engagement, but the researchers showed that it is not built through goodwill alone. It grows from culturally competent practice, genuinely inclusive processes and deliberate power-sharing arrangements that signal to participants that their contributions carry real weight. Where marginalized communities face complicated rules, past negative experiences or services that feel alien to their culture and needs, involvement is unlikely. But when co-production makes services feel more respectful, inclusive and human, people develop a sense of warmth, belonging and confidence, and they become willing to stay engaged, speak up and help shape services that work for everyone.

The study also articulated its dark twin, a rival theory that will resonate with anyone who has sat through a poorly run consultation. When organisations invite communities in without real commitment, when leaders withhold support, when staff lack facilitation skills or when old hierarchies quietly reassert themselves, participation becomes tokenistic. Participants recognise the tick-box exercise for what it is, trust in services falls, people withdraw, and services remain out of touch with the communities they are meant to serve. The researchers emphasise that this failure mode is not a marginal risk but a common trajectory, and that avoiding it requires structural change rather than better marketing of involvement exercises.

Three further clusters of findings flesh out the conditions for authentic collaboration. Sustainable co-production, the synthesis found, depends on visible leadership commitment, long-term investment and genuine opportunities for skill development and emotional support for participants. Ethical integrity and trauma-informed facilitation proved essential for creating safe spaces in which people felt respected and brave enough to share their vulnerability, a point that matters enormously when services touch on sensitive areas such as housing, social care and family support. Cross-sector collaboration and systems thinking, meanwhile, enabled shared purpose and accountability across organisational boundaries, allowing councils, health services and community organisations to act as a coherent whole rather than a patchwork of competing priorities.

Evaluation emerged as a final, often neglected pillar. The researchers found that participatory and creative approaches to evaluation do more than measure impact; they actively strengthen trust, demonstrate to participants that their input made a difference, and promote continuous learning within the organisation. Concepts such as trust, power-sharing and leadership commitment, the authors note, operated recursively across different contexts and at varying system levels, meaning that the same mechanisms that launch a co-production project must be continuously renewed to sustain it. This recursive quality helps explain why one-off involvement initiatives so often fade: the mechanisms that spark engagement are treated as launch requirements rather than ongoing obligations.

The conclusions carry practical weight for local authorities under pressure to involve communities in decisions about health determinants and public services. Authentic co-production, the study argues, depends on aligning relational trust, ethical practice and structural support within learning cultures that genuinely value lived experience. That alignment is not achieved through a single intervention but through the everyday culture and governance of the organisation, from how meetings are facilitated to how budgets are committed and how results are fed back to participants. The synthesis advances theoretical understanding of co-production as a complex system phenomenon, but it also offers a practical checklist for officers and councillors: build trust through inclusive, culturally competent practice; share power visibly; invest for the long term; support participants emotionally and skilfully; facilitate with trauma-informed care; collaborate across sectors with shared accountability; and evaluate creatively and participatorily.

For a field often criticised for producing enthusiasm without evidence, this realist synthesis provides something rare: a theoretically grounded, empirically tested account of the causal machinery beneath co-production. Its message is ultimately hopeful. When local authorities get the conditions right, people who have been marginalised by services become their most valuable designers, and the resulting services are more equitable, more trusted and more effective. When they get the conditions wrong, involvement becomes theatre, and cynicism deepens. The difference, this research shows, lies not in the idea of co-production itself but in the trust, ethics and structural commitment that surround it.

Subject of Research: Realist synthesis of how co-production of local authority services works, for whom and under what circumstances

Article Title: Realist synthesis of co-production of services in a local authority context: what works, for whom, how and in what circumstances?

Article References: Harding, A., Larbi, R. T., Lowndes, A., Marshall, P., Mars, A., Goodridge, M., & Wigglesworth, P. (2026). Realist synthesis of co-production of services in a local authority context: what works, for whom, how and in what circumstances?. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01522-0

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01522-0

Keywords: co-production, local authority, realist synthesis, public services, trust, power-sharing, community engagement, health determinants, participatory evaluation, systems change, lived experience, trauma-informed facilitation